A nursing fitness to practise committee has recommended the censure of a staff nurse at a Health Service Executive care facility for inappropriate behaviour towards two residents in 2014.
Committee chairwoman Muireann Ní Shúilleabháin said that, subject to the approval of the Nursing and Midwifery Board of Ireland (NMBI), the committee had decided to recommend that the inquiry into the nurse’s behaviour be dispensed with, based on the undertaking proposed by the nurse to consent to her being censured by the board, not to repeat the behaviour and to undergo several training courses.
Friday was the second day of the inquiry into allegations of inappropriate behaviour by the nurse on or around November 8th, 2014, regarding two residents, A and B, at the facility.
The allegations included that the nurse acted aggressively towards A. It was alleged that the nurse pointed away when speaking to A and shouted “go” and/or pushed A’s hands down and told her to “go and sit in the chair” when A raised her hands toward the nurse and/or inappropriately used her forehead against A.
RM Block
It was further alleged that the nurse acted inappropriately towards B in that while feeding B, she continuously slapped the resident’s hand away and pinched the resident’s nose to get her to swallow food.
It was further alleged that on another occasion, the nurse, while feeding B, repeatedly pinched the resident’s nose to encourage swallowing and held her hands down while doing so.
In delivering the committee decision, Ms Ní Shúilleabháin said that suspending the nurse from the register would not be a proportionate sanction and outlined several factors that contributed to mitigation and proportionality.
She said that due to the environment in which the nurse was working, she lacked an understanding of the appropriate techniques. Ms Ní Shúilleabháin added that the nurse did not return to work for seven years due to a locally imposed suspension and that this was significant.
She said the nurse had apologised for her behaviour, which demonstrated insight. She added that since returning to work in the same care facility in 2021, the nurse has maintained an unblemished record and undertaken numerous relevant courses.
Ms Ní Shúilleabháin also noted the references provided by management at the care facility since the nurse returned to work there and from the church of which she is a member, which indicated that she was a valued employee and member of the community.
The chairwoman continued that the delay of over a decade since the events took place has taken a considerable toll on the nurse. She added that there was a low likelihood of the behaviour being repeated and that the proposed undertaking by the nurse demonstrated further insight.
She concluded that the sanction of censure would act as a public mark of disapproval of the behaviour of the nurse and satisfied the need to uphold the integrity of the profession in the eyes of the public.
Barrister Eoghan O’Sullivan, for the chief executive of the NMBI, earlier told the inquiry that the chief executive was neutral regarding the nurse’s application to agree to be censured.
Barrister William Maher for the nurse said that there was a context which was relevant to a better understanding of the nurse’s behaviour, including that she was unfamiliar with the particular facility in which the residents were in care and that she did not have in-depth knowledge of the residents.
Mr Maher also added that the previous experience of another service user of dying from malnutrition gave rise to concerns by members of staff at the care facility and the nurse.
Mr Maher further added that the technique of the nurse of pinching the nose of residents to get them to swallow food was “learned in a different context” in an operating theatre setting and that it was an “historic practice”.
“It’s not a learned practice for a feeding technique, but in the circumstances presented to her, that’s what she did. She was acting in good faith. She understands how inappropriate this approach was; she has undergone training,” he said.
“It should never have happened. The registrant knows that what happened was wrong and she regrets that,” he added.
Mr Maher said, based on the evidence, the nurse used “brief minimal force, demonstrates concern for the service users, there are incidents of chat directed towards service users, [and] she didn’t rush the service users”.
He also added that the nurse’s behaviour was not subject to criminal investigation.
A direction regarding the anonymisation of the nurse’s name, locality, current place of employment, family members, all factual witnesses, the name and location of the care centre and the names of its residents, staff and anyone connected with it applied to Friday’s hearing and any reporting of it.
Ms Ní Shúilleabháin adjourned the inquiry pending the board’s decision regarding the proposed undertaking of the nurse.
